Schoeppler Gita M, Zaak Dirk, Schuhmann Petra, Stief Christian G, Buchner Alexander
Department of Urology, University Hospitals - Grosshadern, Ludwig-Maximilians-University Munich, Germany.
Scand J Urol Nephrol. 2012 Oct;46(5):337-42. doi: 10.3109/00365599.2012.689006. Epub 2012 May 21.
The aim of this investigation was to determine whether postoperative urine colour could be used as a predictor for the presence or absence of a urinary leakage at the vesicourethral anastomosis after open radical prostatectomy.
In this prospective study, the urine colour of 223 patients who underwent open radical prostatectomy due to histologically proven localized prostate cancer was assessed macroscopically and microscopically on postoperative day (POD) 6, 7 and 8. All patients underwent evaluation of perianastomotic extravasation by retrograde cystography on POD 8. Baseline characteristics included age; prostate-specific antigen; prostate volume; tumour, node, metastasis classification; and Gleason score.
The urine colour was a highly significant predictor for perianastomotic extravasation in cystography when it was red on POD 6, 7 and 8. The sensitivity and specificity of urine colour as a predictor for extravasation were 71.4% and 83.2% on POD 6, 71.4% and 85.8% on POD 7, and 81.8% and 90.9% on POD 8, respectively, with a clear or slightly ensanguined urine colour. The negative and positive predictive values were 98.6% and 81.8%, respectively.
A cystography can be omitted if the patient demonstrates a clear urine colour on POD 8, without an increased risk of missing a perianastomotic extravasation.
本研究旨在确定开放性根治性前列腺切除术后尿液颜色是否可作为膀胱尿道吻合口尿漏存在与否的预测指标。
在这项前瞻性研究中，对223例因组织学证实为局限性前列腺癌而接受开放性根治性前列腺切除术的患者，在术后第6、7和8天对其尿液颜色进行宏观和微观评估。所有患者在术后第8天通过逆行膀胱造影评估吻合口周围外渗情况。基线特征包括年龄、前列腺特异性抗原、前列腺体积、肿瘤、淋巴结、转移分类以及 Gleason 评分。
当术后第6、7和8天尿液呈红色时，尿液颜色是膀胱造影中吻合口周围外渗的高度显著预测指标。尿液颜色作为外渗预测指标的敏感性和特异性在术后第6天分别为71.4%和83.2%，术后第7天分别为71.4%和85.8%，术后第8天分别为81.8%和90.9%，尿液颜色为清亮或略呈血性。阴性预测值和阳性预测值分别为98.6%和81.8%。
如果患者在术后第8天尿液颜色清亮，则可省略膀胱造影，而不会增加遗漏吻合口周围外渗的风险。
